Report #2878415

Received Dec 17, 2025

Hospitalized

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Overview

Sex: Female
Age: 86 yrs
State: WI
Recovered: Recovered
Vaccinated: Oct 27, 2025
Onset: Oct 27, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (UNKNOWN))	UNKNOWN MANUFACTURER	1	3052996	IM / AR

Symptoms (4)

DyspnoeaHypersensitivityOxygen saturation abnormalPyrexia

Symptom narrative

Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Fever-Severe, Additional Details: She came after like a month & informed us that she got a severe allergic reactions resulted in hospitalization afer hrs from getting the vaccine, she mentioned oxygen off & body temo 104